台湾地区严重血友病性关节炎患者行全膝关节置换术：一项基于人群的全国性回顾性研究。
Total knee replacement for patients with severe hemophilic arthropathy in Taiwan: A nationwide population-based retrospective study.
机构信息
Division of Joint Reconstruction, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Surgery, School of Medicine, National Yang Ming Chiao Tong University, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2022 Feb 1;85(2):228-232. doi: 10.1097/JCMA.0000000000000646.
BACKGROUND
Total knee replacement (TKR) surgery is a treatment option for advanced hemophilic arthropathy. Due to its rarity and complexity, previous reports could only demonstrate the results of single-site studies including few cases. This population-based study aimed to investigate the major epidemiological characteristics, mean consumption of coagulation factors, length of hospital stays, complications, and failure rate of primary TKR for severe hemophilia patients in Taiwan.
METHODS
A cohort of 996 hemophilia patients registered between 1995 and 2011 was included, and 103 primary TKRs were performed on 75 patients. Unilateral TKR was performed on 47 patients and bilateral TKRs on the remaining 28 patients, including 12 simultaneous and 16 staged surgeries. The mean age at surgery was 32.3 years (range, 17.3-55.7), and the mean follow-up duration was 77.9 months (range, 2.3-176.8).
RESULTS
Failure was noted in 8 patients (8.5%) at mean 32.8 months (range, 2.3-95) after surgery. Four patients revealed aseptic loosening, whereas infection in 4. The 10-year prosthesis survivorship was 88.6%. For patients receiving unilateral TKR, the mean length of hospital stay was 15 days (range, 7-32). The mean cost of factor supplement was United States Dollar (USD) 43 543 with a mean 4-unit packed red blood cells transfusion (range, 0-38). The total admission cost was USD 48 326 (range, USD 4165-262 619).
CONCLUSION
The prevalence of TKA for hemophilia patients was 7.5% in Taiwan. The mean hospital stay was 14 days, and the 10-year prosthesis survivorship was 88.6%. The mean daily factor usage was decreased from 235.7 units preoperatively to 202.1 units postoperatively. In comparison with the staged-bilateral TKRs, the simultaneous procedures significantly reduced the mean total cost from USD 101 923 to USD 61 587 (p = 0.023). Therefore, in terms of cost-effectiveness, bilateral simultaneous TKR is more preferable than staged procedures.
背景
全膝关节置换术（TKR）是治疗晚期血友病性关节病的一种选择。由于其罕见性和复杂性，之前的报告只能展示少数病例的单中心研究结果。本项基于人群的研究旨在调查台湾严重血友病患者初次 TKR 的主要流行病学特征、凝血因子平均消耗量、住院时间、并发症和翻修率。
方法
纳入了 1995 年至 2011 年间登记的 996 例血友病患者，75 例患者共进行了 103 例初次 TKR。47 例患者行单侧 TKR，28 例患者行双侧 TKR，其中 12 例为同期手术，16 例为分期手术。手术时的平均年龄为 32.3 岁（17.3-55.7 岁），平均随访时间为 77.9 个月（2.3-176.8 个月）。
结果
术后平均 32.8 个月（2.3-95 个月）时，8 例（8.5%）患者出现翻修。4 例为无菌性松动，4 例为感染。10 年假体生存率为 88.6%。行单侧 TKR 的患者，平均住院时间为 15 天（7-32 天）。凝血因子补充的平均费用为 43543 美元，平均输 4 单位浓缩红细胞（0-38 单位）。总住院费用为 48326 美元（4165-262619 美元）。
结论
在台湾，血友病患者接受 TKA 的比例为 7.5%。平均住院时间为 14 天，10 年假体生存率为 88.6%。与分期双侧 TKR 相比，同期双侧 TKR 可显著降低总费用（从 101923 美元降至 61587 美元，p=0.023）。因此，从成本效益的角度来看，双侧同期 TKR 比分期手术更具优势。
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